Harleysville M. Ins. Co. v. Cat. L. Tr. F.

515 A.2d 1039, 101 Pa. Commw. 215
CourtCommonwealth Court of Pennsylvania
DecidedOctober 6, 1986
Docket2660 C.D. 1985 and No. 2659 C.D. 1985
StatusPublished

This text of 515 A.2d 1039 (Harleysville M. Ins. Co. v. Cat. L. Tr. F.) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harleysville M. Ins. Co. v. Cat. L. Tr. F., 515 A.2d 1039, 101 Pa. Commw. 215 (Pa. Ct. App. 1986).

Opinion

101 Pa. Commonwealth Ct. 215 (1986)
515 A.2d 1039

Harleysville Mutual Insurance Company, Harleysville, Pennsylvania 19438 (Van Laufer Matter), Petitioner
v.
Catastrophic Loss Trust Fund et al., Respondents.
Employee Benefit Plan of Harleysville Mutual Insurance Company, Harleysville, Pennsylvania 19438 (Lyons Matter), Petitioner
v.
Catastrophic Loss Trust Fund et al., Respondents.

No. 2660 C.D. 1985 and No. 2659 C.D. 1985.

Commonwealth Court of Pennsylvania.

Argued February 6, 1986.
October 6, 1986.

*216 Argued February 6, 1986, before Judges BARRY and PALLADINO, and Senior Judge BLATT, sitting as a panel of three.

Jane Dalton Elliott, with her, James J. McCabe and Carolyn Mills, Duane, Morris & Heckscher, for petitioners.

Michael L. Harvey, Deputy Attorney General, with him, Allen C. Warshaw, Executive Deputy Attorney General, Chief, Litigation Section, and LeRoy S. Zimmerman, Attorney General, for respondents.

OPINION BY JUDGE BARRY, October 6, 1986:

Before us are preliminary objections filed by respondents, the Catastrophic Loss Trust Fund (CAT Fund), opposing the petitions for review filed in this court's *217 original jurisdiction by petitioners, the EMPLOYEE BENEFIT PLAN of Harleysville Mutual Insurance Company (BENEFIT PLAN) and Harleysville Mutual Insurance Company (HMIC), filing as a separate entity. The petitions seek a declaratory order that the CAT Fund is obligated to provide benefits to Mrs. Marion Lyons, an employee of HMIC and a member of its BENEFIT PLAN[1] and to Mr. DeForrest Van Laufer, a no-fault automobile insurance policyholder insured by HMIC; that both the petitioners are entitled to reimbursement from the CAT Fund for benefits due Mrs. Lyons and Mr. Van Laufer; and that a resolution adopted by the CAT Fund Board of Directors which orders the CAT Fund Administrator to deny benefits to no-fault automobile insurance policyholders is invalid. The petition further asks that we issue a writ of mandamus compelling the CAT Fund to reimburse petitioners.

In its preliminary objections the CAT Fund argues that the petition must be dismissed inasmuch as this matter is exclusively within the jurisdiction of the Insurance Commissioner and petitioners have failed to exhaust this remedy.

FACTS

The Motor Vehicle Financial Responsibility Law

On February 12, 1984 the Motor Vehicle Financial Responsibility Law (Financial Responsibility Law), Act of February 12, 1984, P.L. 26, 75 Pa. C. S. §§1761-1769, was enacted, effective October 1, 1984. The Financial Responsibility Law contained the provisions *218 which established the CAT Fund and repealed the NO FAULT Act.[2] The Fund provides for catastrophic loss benefits to injured automobile accident victims. These benefits are defined under Section 1766 of the Financial Responsibility Law, 75 Pa. C. S. §1766, as those reasonable and necessary expenses due to an injury arising out of the maintenance or use of a motor vehicle which exceed $100,000. In addition, the Financial Responsibility Law created and described the duties of the CAT Fund's Board of Directors and Administrator, appoints the Insurance Commissioner as the Chairman of the CAT Fund Board of Directors, 75 Pa. C. S. Section 1765, and provides that CAT Fund benefits are "primary to any other source of accident and health benefits." See Section 1766(c) of the Financial Responsibility Law.

Marion Lyons

Mrs. Marion Lyons was issued a no-fault policy prior to October 1, 1984, the effective date of the Financial Responsibility Law. This policy was still in effect at the time of Mrs. Lyons' accident on December 8, 1984. At that time, Mrs. Lyons was an employee of HMIC and a member of its medical benefits program. The BENEFIT PLAN has paid and continues to pay Mrs. Lyons' medical expenses. Under its terms, the BENEFIT PLAN is subrogated to Mrs. Lyons' right to recover from the CAT Fund. Mrs. Lyons filed a claim with the Fund for those benefits in excess of $100,000.[3] This claim was denied on the basis of a resolution of the CAT Fund dated June 26, 1985.[4] The BENEFIT PLAN itself *219 never filed a claim for benefits but, by letter dated September 26, 1985, expressed dissatisfaction with the denial of benefits to Mrs. Lyons and a desire to appeal that decision. On October 10, 1985 the Fund informed the BENEFIT PLAN that it did not qualify as a claimant for benefits, in effect dismissing the BENEFIT PLAN's request to appeal the denial of Mrs. Lyons' claim. By letter dated October 31, 1985, the CAT Fund informed the BENEFIT PLAN that it could appeal the October 10, 1985 decision under the CAT Fund appeal regulations.

DeForrest Van Laufer

Mr. Van Laufer was issued a no-fault policy by HMIC prior to October 1, 1984, the effective date of the Financial Responsibility Law. This policy was in effect when Mr. Van Laufer was seriously injured in an automobile accident on October 30, 1984. The CAT Fund denied Mr. Van Laufer's claim for benefits on August 23, 1985, on the basis of the June 26, 1985 resolution. Mr. Van Laufer appealed to the Bureau of Insurance Consumer Affairs of the Insurance Department, which refused to address the validity of the resolution and directed Mr. Van Laufer to the Insurance Commissioner. HMIC claims that it has attempted to intervene to petition for a hearing and has petitioned for consolidation with Mrs. Lyons' claim.

To summarize the petitioners' involvement, the BENEFIT PLAN never filed a claim for benefits but challenged, by way of a series of correspondence to the CAT Fund, the denial of the claim filed by a member of its employee medical benefits program, Mrs. Lyons. *220 Having received no satisfaction at the administrative level, the BENEFIT PLAN filed a petition in our original jurisdiction challenging the CAT Fund's decision and the adoption of the resolution of June 26, 1985. HMIC, while not challenging the denial of CAT Fund benefits to its insured, Mr. Van Laufer, or the validity of the resolution at the administrative level, joins the BENEFIT PLAN in its challenge under our original jurisdiction.[5]

PRELIMINARY OBJECTIONS

The CAT Fund has filed preliminary objections requesting that we dismiss the petitions because petitioners have failed to exhaust their exclusive administrative remedies under Section 1768 of the Financial Responsibility Law and Section 504 of the Administrative Agency Law, 2 Pa. C. S. §504.

Section 1768 of the Financial Responsibility Law provides:

If any person making a claim for benefits from the Catastrophic Loss Trust Fund disputes a determination of the administrator concerning eligibility for benefits, allowance of benefits of otherwise, the person so claiming may request that the Insurance Commissioner review the determination of the administrator. The Insurance Commissioner shall provide the person so claiming and the administrator the opportunity to present statements or other documents and, at the election of either of these individuals, the opportunity for a hearing pursuant to Title 2 (relating to administrative law and procedure).

Id. (75 Pa. C. S. §1768).

*221

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Harleysville Mutual Insurance v. Catastrophic Loss Trust Fund
515 A.2d 1039 (Commonwealth Court of Pennsylvania, 1986)

Cite This Page — Counsel Stack

Bluebook (online)
515 A.2d 1039, 101 Pa. Commw. 215, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harleysville-m-ins-co-v-cat-l-tr-f-pacommwct-1986.